The Department of Preventive Medicine of the University of Iowa College of Medicine was contracted to prepare a document addressing the research needs for maintaining the safe mobility of older women in the United States, with an emphasis of automobile driving as well as other modes of transportation. This activity was funded by a grant from the National Safety Council. The specific objectives were:

Review of the available literature and selective consultation with non-published sources and relevant investigators were undertaken, and a few major databases were analyzed to provide the information in the report. We took a population approach to assessing the information summarized here. That is, we emphasized geographically- referent studies and surveys over the larger volume of important organizational, social, transportation and clinical research that employed small, selected samples of persons for study. The lack of critical population research in many relevant areas made addressing some of research questions difficult and tentative, relegating them to becoming part of the research agenda, summarized below.

Major conclusions from evidence are as follows:

• The number of older women in the United States will continue to increase at a substantial rate, both due to increased survivorship and immigration.

• Currently, about 20 percent of American women over age 65 do not operate an automobile, both for reasons of quitting motor vehicle operation and because of never having been a driver. However, successive cohorts of older women will likely be all but universally be motor vehicle operators, at least at some point in their lives, as is true of men.

• There is confusion in the gerontological and geriatric literature on the difference between disability and mobility. Most population data on the health and function of older women emphasize disability as a set of physical movement disorders often related to medical conditions, rather than mobility, the ability to move from one place to another to achieve social and recreational ends. While there is substantial information on disability rates among older women, there is very little population-based information on the status of mobility and transportation, nor are there published projections for the next few decades.



• Older women, as older men, continue to depend heavily on the automobile for transportation, and based on federal surveys, that is still increasing. Over the past decade, the use of public transportation has declined marginally. Walking to achieve mobility has also declined. The reasons for these changes have not been systematically evaluated, although focus groups as well as qualitative and "clinical" research has suggested some important reasons.



• With the increase in the number of older women, there are also contradictory trends that will make projecting motor vehicle operating patterns and transportation needs extremely difficult. For example, tomorrow’s older women will have smaller families with fewer children to provide social and transportation support, aided by high divorce rates among today’s younger and middle-aged women. On an age-specific basis, they will likely be more healthy than today’s cohorts, but living longer will lead to more late-onset physical and cognitive disability, leading to substantial challenges in sustaining safe mobility. On the other hand, older women will be more educated and at least a portion will be more affluent, fostering self-sufficiency. Assessing future trends in availability of safe, acceptable public transportation and urban and regional design, as well as assistance in mobility for those with overt handicaps is most difficult. There are also particular problems in transportation access for rural women. On balance, these complex and divergent trends make projection of the net effect on mobility needs for the next generation complex.



• A large number of recent and concurrent national surveys with information relevant to the safe mobility of older American women. Many offer important segments of the research information needed for policy and planning, but all are deficient in elements of content necessary for a comprehensive approach to this issue. Other types of informative research were reviewed and deficient content areas were also noted.

The report concludes with research recommendations based on the review of the scientific evidence and ancillary consultations and communications. In general these recommendations call for more targeted research in the following areas:

• Population surveys should be expanded in content in order to provide a sufficient breadth in areas such as personal social goals, priority mobility needs and access to and perceptions of all common varieties of public and private transportation, as well as evaluating current usage of transportation.



• Measures of physical and cognitive disability used in population survey research should be further developed and validated to more accurately reflect older women’s abilities to use various kinds of public transportation as well as personal motor vehicles.



• Special attention needs to paid the increasing cohorts of young and middle-aged persons who were disabled at an earlier age and now approaching older ages because of advances in health care and rehabilitation. Their mobility needs may be different in a variety of important ways.



• Research needs to be conducted on the relation of personal wealth and assets to transportation access. Economic factors seem to be extremely important for at least a quarter of the population and these factors need to be better understood if safe mobility for the entire population is a goal.



• Demographic projection and forecasting techniques should be enhanced to define for the next few decades not only the population size and survivorship of older women, but also family and social network size and availability, the levels of transportation-related disability and economic access to personal and public transportation.



• Additional targeted research is needed on the personal perceptions of older women with respect to access, acceptability and utility of all modes of transportation and other sources of mobility, as well as personal mobility needs and desires, in order to more effectively plan for mobility needs.



• More study is needed on the evolution of urban and regional design changes that affect the mobility of older women. Changes that promote safe mobility should be championed. Also, the impact of assisted living facilities and other newer modes of residential design for older persons in general and older women in particular should be evaluated for their impact on transportation needs.

The overall purpose of this report is to review the status of transportation and mobility research concerning older women in the United States. Some research is drawn from other countries, mostly in western Europe, but the intent is to understand the domestic situation, which usually will be based on domestic investigations. Studies on health, transportation and automobile driving are often not in the formal, peer-reviewed medical literature, and thus we sought conference reports and consulted prominent investigators and research program directors in this area, but it is not likely that the entirety of the relevant literature was found. In addition, while there are several population surveys that offer considerable insight into the issues at hand, some have become dated and decreasingly relevant only because there are important long-term and sometimes rapidly changing trends in the use of transportation and motor vehicles among older women. These trends require forecasting techniques to determine some of the issues for the next several decades, which is hazardous and uncertain at best, and not a substitute for continual data collection to assess the actual situation among older women. While the automobile dominates transportation utilization for most Americans, older and younger, male and female, we have tried to review some of the less robust literature on other modes of transportation. Some of the tables provided here are from unpublished data of the reports’ authors, and that will be specifically noted.

The final "product" of this report will offer suggestions for encompassing surveys that have sufficient breadth of content to more fully assess the older women’s transportation issues. The language of this report will be aimed at the educated lay person, and to the best of our ability we have eliminated as much jargon as possible from the text. In some places it will be unavoidable, and the next section of this report will deal with some of the vocabulary and definitional issues.

II. Some Definitional and Conceptual Issues Related to Transportation and Mobility While mobility and transportation issues form the major substance of this report, an introduction on the basic definitions of mobility and disability, and relevant conceptual issues from the health and gerontology literature is of value:

This section will describe the problems with assessing disability, dysfunction and mobility, as well as how it might relate to socio-economic status (SES) and gender. This is a complex area but the brief review is done with the intent of relating function to automobile driving and its cessation.

1. Interpreting Disability and Dysfunction

In this section, we will review the major trends in disability, mobility, transportation and quality of life among older populations, with an emphasis on gender differences. As the discussion progresses, deficits in our understanding and data needs will be highlighted.

According to results from the 1995 Nationwide Personal Transportation Survey (NPTS), 82 percent of women over age 65 years report themselves as active automobile drivers; until age 80 years the majority of women report themselves as drivers. In this cross-sectional survey, it is about at age 75 years when older women’s driving rates begin to decline substantially. At age 85 years only 36 percent report themselves as currently driving (Figure 1).

In contrast, 95 percent of men in the 1995 NPTS report current driving at ages 60-64 years and 78 percent of men over age 85 report themselves as drivers. The difference in self-reported driving status between men and women has narrowed over the past decade. The 1983 NPTS indicated that 75 percent of women age 60-64 were licensed to drive, and that number increased to 82 percent by 1990. (By comparison, the number of men licensed to drive increased from 93 to 95 percent.) Of those age 85 years and above, the percent of those licensed to drive increased from 11 to 24 percent (Burkhardt, Berger and McGavock, 1996). As noted above, we expect that with each succeeding generation of elders, the proportion of older women drivers is likely to approach and equal that of men.

Important ramifications exist for elder women transportation issues as the current cohort of "baby boom" women age. By all measures of current and predicted mobility, including licensing, current mileage driven and vehicle ownership and access, baby boom generation women (currently aged 40-55 years) have substantially higher levels than today’s women 65 years and older when they were the same age. As shown in Figure 5, when the current baby boom women are over age 65 years, they will more likely be the head of a household, more well educated and more likely to have had a long career in the labor force. This suggests that in the next decades demands for increased mobility among older women will be greater for social activities, including employment, recreation, community volunteering and support for other family members (Jette, 1997). This in turn will have important implications for road construction and the environmental burdens of the automobile.

As noted above, automobile driving status in older women is associated with personal and family income, as shown in Figure 2 from the NPTS. The situation for older women living alone is different than those in a multiple-person household, with significantly more elder women who live alone continuing to drive, at least past the age of 75 years (Figure 3). This can be interpreted as a selection factor, with less healthy older women driving less and being less capable of living alone. However, it is also worth exploring whether the continued ability and willingness to drive is associated with a longer period of independent living. Figure 4, which shows the relation of age and income to driving status only among women living alone suggests that there is more income discrimination as to driving status than among older women in general. This too would seem to merit further investigation as to the determinants of this situation and the possibility that living alone might be a risk factor for mobility interventions.

Figure2.   Proportion of Women who currently drive as a function of age and household income

SOURCE: Bianchi and Spain 1996; U.S. Bureau of the Census 1996, 1997

As older women choose to give up driving based on varying degrees of physical and cognitive disability from aging and health problems, the need increases for alternative transportation to replace automobiles, at least for provision of intra-community mobility. However, public transit, paratransit and taxis or other private transportation do not fully provide the mobility older women expected with the automobile, and therefore many elders do not choose to pursue public transportation as a viable alternative to automobile travel. The 1990 Nationwide Personal Transportation Survey indicated that elders’ reliance on automobile travel is currently increasing, with 91% percent of elders’ trips in 1990 by private vehicle (compared with 86.7% in 1983) and 1.0% of elders’ trips in 1990 by public transit (compared with 2.7% in 1983) (Table 2). An important change is the drop in proportion of persons walking as a transportation mode.

The reason for these barriers to widespread use include the prohibitively high cost of this specialized service, estimated at approximately ten dollars per one-way trip per individual, and the continually changing physical and cognitive status of disabled elders which do not lend themselves well to the rigid requirements of paratransit.

Private transportation including taxi services, while also costly, is an attractive option in an era of public to private sector outsourcing. Although arrangements including public subsidies for taxi services or negotiated taxi rate cuts for a guaranteed number of elders may provide a plausible alternative in some areas, public utilization of private transportation is not standard (Rosenbloom, 1989). It has also been reported that some elders with sufficient fiscal means do not use taxis because of fear of crime and because of such use being a visible indicator of "being rich," that is, flaunting a degree of wealth that peers do not possess.

As noted, a special problem in transportation availability is the difference in rural vs. urban access. As anticipated, rural elder women are in general less able than urban women to rely on public transportation for intra-community mobility (Figure 6). For this reason as well as social reasons, rural elder women are more likely to currently drive (Figure 7).

This may be in part due to a selection bias in which healthier elder women continue to live in rural areas whereas their more physically disabled peers move into town. Investigation is needed to determine if rural women continue to drive despite disablement more than their urban peers due to the lack of mobility options in rural areas.

Analysis of the Established Populations for Epidemiologic Studies of the Elderly suggest that few older women feel that public transportation in rural areas meets their transportation needs, more specifically that rural public transportation does not offer service to areas that are desired destinations (Foley, Eberhard, Ostfeld, Wallace and deWolf, 1990). Walking, usually the chief alternative mode of transport to the car, is simply not a viable alternative in many rural settings. Thus, without alternatives to driving, rural non-driving elders face even higher levels of social isolation than their counterparts in the city (Gonda, 1982).

This section will synthesize the information contained in the above report, and make recommendations for improved data collection on the central issues at hand. While there are substantial gaps in available data (with suggestions made below) some tentative conclusions can be drawn:

1. The number of older women (and men) is increasing rapidly in the United States due to general population growth, immigration and surviving longer. This in itself is an imperative for enhanced planning efforts for the expected increase in mobility and transportation needs.
2. Several trends in the health, economic and social status of older women will make these planning efforts complex. Tomorrow’s older women will likely have somewhat improved longevity and possibly somewhat less disability for a given age than today’s. They will more likely have had a long labor force experience, be more educated and affluent as a group and be responsible for a household. In addition, families will be smaller, creating more pressure for individual older women to be self-sufficient for mobility and transportation needs. All of this will raise the demand for safe mobility and transportation access, and at least in the near future, lead to more use of automobiles.
3. For a given age, older women have more physical disability than men. However, this increased disablement is less associated with severe or fatal illnesses. Disability is complex and, in populations, may have diverse manifestations and differing effects on mobility and the selection of transportation modes. For example, difficulty in walking may lead to more automobile use and less use of public transportation such as urban buses, since getting to the bus stop may be difficult. On the other hand, dysfunctional vision or upper extremity use might have the reverse effect. Given the increasing number of older women and the net increase in those with various dysfunctions, the growing need for environmental modification of transportation modes seems obvious. As described in more detail below there is much more population information on the clinical aspects of physical disability than on mobility and functional transportation use.
4. The selection of and usage rates for various transportation modes is determined by many factors other than health status:

-Economic status is important. After holding health and social status constant, older women in the lowest quarter of family/personal wealth and assets have lesser ownership and use of automobiles, and lesser use of other modes of transportation. This is particularly true of impoverished and minority women.

-Some research suggests that environment factors such as fear of crime and environmental pollution may affect driving and other transportation use rates.

-Living in rural areas, where both public transportation and special transportation services for disabled persons are less available, may lead to diminished mobility among older women compared to their urban counterparts.

-Impediments to safe mobility are determined in part by urban, regional and residential design. Varying designs and architectural patterns may facilitate or deter meeting the social and other sustaining mobility needs of older women (e.g., visiting friends or the doctor, doing grocery shopping). Attention to these design issues will likely improve mobility for older women.

5. The automobile remains the dominant mode for transportation and mobility among older Americans, men and women, and according to national surveys, this dominance is increasing. The literature on driving cessation patterns among older women is incomplete but suggests that most give up driving based on a shared decision with family members, friends and health professionals. Cessation rates increase substantially after age 75 years. Only a very small proportion have driving privileges revoked by state transportation agencies. Older women drivers have lower crash rates than men and, on a per-mile-driven basis, rates remain among the lowest of any demographic group and do not increase much after age 60 years. Whether the increasing mobility needs and lesser availability of family members to provide transportation for older women in the future will lead to less cessation of driving and alter future crash rates is uncertain. This needs to be monitored.

Our overall conclusion is that there are vast needs for data, particularly on the national level, that are unmet. There are several reasons for this general need:

• There is no obvious or published documentation of the policy questions which national or regional surveys might address. This is not to criticize the large amount of useful research or problem identification, but data needs cannot be addressed in the absence of pre-specifying the issues to be addressed in suitable detail.
• Much of the locally conducted research on the issues of older women’s mobility, auto driving and transportation needs has not been reconciled or brought to sufficient national prominence.
• Existing national or regional population-based surveys related to mobility and transportation have been quite useful, but have not contained a sufficient breadth of variables and information on the same individuals so that many of the important issues could be addressed in a comprehensive way.
• Existing surveys on geriatric and gerontological health status have a generally common way of collecting information of physical and psychological disability, but the items structures and formats are often not fully suitable for addressing transportation issues and the use of the automobile and other conveyances. More specific items, many of which have already been applied in surveys, need to be brought to bear on the questions of interest.
• It has been (understandably) difficult to link self-reported family and personal information related to mobility and transportation use to the health, transportation and other relevant data sources within and outside of government. This would greatly enhance the ability to understand many of the data-related issues that can’t be obtained from personal self-report.
• The issues related to safe mobility among older women require a substantial number of disciplines: health and medicine, epidemiology and biostatistics, survey research, transportation engineering and design, human factors, social and behavioral science, etc.
• As far as we can tell, the demographic models employed mostly in the economics sphere have not been brought to bear on the mobility and transportation issues.

Solutions to these issues may be self-evident but execution of the solutions can be extremely difficulty. Thus, the following are a set of logistical and content recommendations to address the data issues remaining and to supplement the existing and important data collection activities. It is appreciated that many of the recommendations below can be costly, and such research should be staged as resources permit. However, while acknowledging the large amount of skillful work that has been conducted to date, there are great gaps in our knowledge of transportation and mobility needs, and these gaps will be unfilled unless addressed aggressively.

1. At least one major national survey, or the upgrade of an existing survey, needs to be conducted at periodic intervals to assess the mobility issues of older women for purposes of planning and policy. While this is not the only mode of research needed, it will supply the data needs most quickly. It is not likely that existing surveys can serve as vehicles (i.e., "piggybacking") because the content will likely be too extensive to be shared with other content areas. The study should be a cohort study because some of the issues, such as determining risk factors for altered transportation use and the impact of changing health and economic status, can only be well-evaluated in longitudinal fashion.
2. Expert, multidisciplinary groups should be convened to determine the content of the surveys as well as the specific item structure. At a minimum, a committee structure to perform this activity should include the following disciplines: economics, law enforcement, insurance, transportation specialists for all the common types of conveyances, epidemiology, human factors, highway design and maintenance, social welfare, physical therapy, automotive medicine, rehabilitation medicine, recreation and leisure studies behavioral science, actuarial science (auto insurance), family economics and sociology, cognitive psychology, state-level transportation officials and urban and regional planning, with specialists in transportation.
3. Before decisions are made on survey content, focus groups and qualitative research should be conducted, building on existing work, to best understand the nature of the problems and develop a set of optimum solutions. For example, if a major barrier for lower SES women is the experience or fear of personal crime, then possible solutions will differ from those where the problem is lack of public transportation. At a minimum, there should be separate study of 1) various levels of urban and rural population density, 2) each of the major ethnic groups in the United States, including samples from areas with mixed ethnicity, 3) groups of varying economic means and 4) groups with varying environmental (contextual) factors, such as weather extremes and traffic density extremes. These groups can be dovetailed, where for example, rural areas are also the lower traffic density areas.
4. As the surveys are planned, consideration should also be given to conducting a set of concordant, targeted experiments to attempt to determine the range (particularly the maximal amount) of social mobility among older women with a standardized set of health characteristics. For example, it might be useful to randomize women of limited economic means who are not automobile operators to a large number of taxi vouchers per month for an extended period to see what the actual increment would be in availing oneself of this transportation access. While is not a reasonable population solution in the long term, it would possibly go a long way toward understanding the "real" outcomes of enhanced mobility.
5. Population surveys should contain a suitable set of cognitive and physical performance tests that build on past work funded by the USDOT and other agencies to determine and apply performance batteries that more closely evaluate the operation of automobiles as well the use of standard public transportation, in order to more accurately determine the population-level ability to operate or use various conveyances. Some additional considerations would be:

1. A set of "existing" gerontologically-applied physical function tests would still be necessary because of the ability of current, standardized measures to reflect and predict overall health status based on the wide variety of existing surveys. Additional analyses to map current gerontological function-status measures onto transportation-related measures would be extremely important.
2. Cognitive tests would need to be of sufficient sensitivity to determine the presence of levels of cognitive impairment or dementia that would lead to either unsafe auto operation or inability to safely use other conveyances.
3. As noted in the recommendation on focus groups above, there would likely be oversampling of various groups of older women in order to have desired statistical power. This might include oversampling of the oldest old, certain minority groups and those with certain illnesses known to put auto drivers at increased safety risk, such as diabetes, seizures and psychotropic medication consumption.

1. Participants in population surveys need to volunteer in advance to link personal data to other clinical and administrative data sources. These latter comprise sources of information for purposes of enhanced analysis and validation of self-report. In some instances, the information would not otherwise be obtainable, and would include: 1) all state information on licensure and reported crashes, 2) medical and related clinical information from the appropriate sources, including the Health Care Financing Administration (Medicare), hospitals and personal physicians and 3) the participants’ insurance company, to understand the nature and activity of auto insurance policies.
2. Given the dominance of automobile travel for older women as well as all other demographic groups, there should be more detailed studies of the income/wealth and assets elasticity as a determinant of automobile ownership and use, as well as the use of other modes of transportation. Then, projections of personal and family wealth among older women can be applied more precisely to determine projected economic access to transportation. Older women in the lowest quartile of income seem to be most sensitive to maintaining auto ownership and use.
3. In addition to population surveys, consideration should be given to surveys of providers of public and quasi-public transportation. It would seem of great use to document the problems and issues of older women’s mobility as seen through the eyes of paratransit operators, bus drivers, taxi companies and other such operators. In addition, there is a source of transportation not well characterized at the present time on a population basis—the transportation provided by life care residential settings. More and more older women are living in guarded or elder-dedicated residential settings that supply transportation of varying levels of coverage and frequency that are not well-defined from a population perspective. This needs cataloging and registration because it appears to be a rapidly emerging source of mobility.
4. A separate but growing issue is the increasing number of older women whose disability and mobility impairments were acquired in early or mid life. This may have been through developmental disabilities, disease, trauma or other causes. Their mobility desires and needs are all but totally unstudied, and there is a need for all types of qualitative and quantitative investigations to determine the types of transportation used and required, and the social settings in which they occur.
5. There is a need for further qualitative studies of the pathways to cessation of automobile driving by older women. While structured surveys can provide part of the answer, there is likely to be a rich and diverse set of circumstances that will not be captured that way. It is not merely the older woman driver who needs study; there should be interviews of other family members, physicians, friends, state officials and others who may have been involved in the decision-making activity.
6. Long term studies of the city and regional planning methods that may promote improved mobility of older women need to be conducted. While there may be little quantification in this area, emerging ideas, trends in design and assessments of outcomes and implications need to be monitored.

Administration on Aging. Meeting the Challenge: Mobility for Elders. Administration on Aging, Washington: December 1994.

Administration on Aging. National Eldercare Institute on Transportation Final Report. Administration on Aging, Washington: 1996.

Administration on Aging. The National Phone Conversations. Administration on Aging, Washington: October 1994.

Anderson RT. James MK. Miller ME. Worley AS. Longino CF Jr. "The timing of change: patterns in transitions in functional status among elderly persons." Journals of Gerontology. Series B, Psychological Sciences & Social Sciences. 53(1):S17-27, 1998 Jan.

Atchley RC. The Social Forces in Later Life. Belmont, CA, Wadsworth: 1994.

Ball K. "Attentional problems and older drivers." Alzheimer Disease & Associated Disorders. 11 Suppl 1:42-7, 1997 Jun.

Ball K. et al. "Driving Avoidance and Functional Impairment in Older Drivers" Accident Analysis & Prevention. Vol. 30 No. 3 (1998) pp. 313-322.

Bianchi SM. Spain D. 1996. "Women, work, and family in America" Population Bulletin Vol. 51, No. 3. Washington, D.C.: Population Reference Bureau.

Barusch AS. Older Women in Poverty: Private Lives and Public Policies. New York, Springer Publishing Company: 1994.

Boult C. Kane RL. Boult L. McCaffrey D. "Chronic Conditions that Lead to Functional Limitation in the Elderly" Journal of Gerontology. Vol. 49 No. 1 (1994) pp. M28-M36.

Brainn PA. Safety and Mobility Issues in Licensing and Education of Older Drivers. US Department of Transportation National Highway Traffic Safety Administration, Publication DOT HS-7-01502, June 1980.

Buchner DM. "Preserving Mobility in Older Adults" WJM. Vol. 167 No. 4 (1997) pp. 258-264.

Bullard RD. Johnson GS. "Just Transportation." In Just Transportation, RD Bullard and GS Johnson, eds. New Society, Stony Creek, CT, 1997.

Burkhardt J. Berger AM. McGavock AT. "The Mobility Consequences of the Reduction or Cessation of Driving by Older Women" In Women’s Travel Issues: Proceedings from the Second Conference. Federal Highway Administration Publication FHWA-PL-97-024, pp. 439-454.

Centers for Disease Control and Prevention. "Mortality Patterns — United States, 1996." Morbidity and Mortality Weekly Report. 46 (40): 941-944, Oct. 10 1997.

Chipman ML. Payne J. McDonough P. "To Drive or Not to Drive: The Influence of Social Factors on the Decisions of Elderly Drivers" Accident Analysis & Prevention. Vol. 30 No. 3 (1998) pp. 299-304.

Clark DO. Stump TE. Hui SL. Wolinsky FD. "Predictors of Mobility and Basic ADL Difficulty Among Adults Aged 70 Years and Older" Journal of Aging and Health. Vol. 10 No. 4 (1998) pp. 422-440.

Cornoni-Huntley J. Ostfeld AM. Taylor JO. Wallace RB. Blazer D. Berkman LF. Evans DA. Kohout FJ. Lemke JH. Scherr PA. et al. "Established populations for epidemiologic studies of the elderly: study design and methodology." Aging. 5(1):27-37, 1993 Feb.

Coughlin JF. Straight A. "Healthy Aging and Transportation Needs." Presented to The Older Driver, Health and Mobility, Trinity College Dublin. September 18-19, 1998.

Cox AB. Cox DJ. "Compensatory driving strategy of older people may increase driving risk [letter]." Journal of the American Geriatrics Society. 46(8):1058-9, 1998 Aug.

Crimmins EM. Saito Y. Reynolds SL. "Further evidence on recent trends in the prevalence and incidence of disability among older Americans from two sources: the LSOA and the NHIS." Journals of Gerontology. Series B, Psychological Sciences & Social Sciences. 52(2):S59-71, 1997 Mar.

Doble SE. et al. "Measuring Functional Competence in Older Persons with Alzheimer’s Disease." International Psychogeriatrics. 9 (1): 25-38, 1997.

Duke University Center for Demographic Studies. National Long-Term Care Survey, NLTCS Public Use Data, 1982, 1984, 1989, 1994. Durham, NC, 1998.

Dulisse B. "Older drivers and risk to other road users." Accident Analysis & Prevention. 29(5):573-82, 1997 Sep.

Eberhard JW. "Safe Mobility for Senior Citizens" IATSS Research. Vol. 20 No. 1 (1996) pp. 29-37.

Edwards SD. "Dismantling the Disability/Handicap Distinction." The Journal of Medicine and Philosophy. 22:589-606, 1997.

Evans L. Traffic Safety and the Driver. Van Nostrand Reinhold, New York: 1991. pp. 19-43.

Foley D. Eberhard JW. Ostfeld AM. Wallace RB. deWolf V. "Design of a Driving Practices Survey in the Established Populations for Epidemiologic Studies of the Elderly." Presentation at the American Statistical Association 151st Annual Meeting, Anaheim, CA (1990).

Forrest KY. Bunker CH. Songer TJ. Coben JH. Cauley JA. "Driving patterns and medical conditions in older women." Journal of the American Geriatrics Society. 45(10):1214-8, 1997 Oct.

Fried LP. et al. "Physical Disability in Older Adults: A Physiological Approach" J Clin Epidemiol. Vol. 47 No. 7 (1994) pp. 747-760.

Galanos AN. Fillenbaum GG. Cohen HJ. Burchett BM. "The comprehensive assessment of community dwelling elderly: why functional status is not enough." Aging. 6(5):343-52, 1994 Oct.

Gauthier S. Gélinas I. Gauthier L. "Functional Disability in Alzheimer’s Disease." International Psychogeriatrics. 9(1) Suppl.: 163-165, 1997.

Gonda J. "Transportation, Perceived Control, and Well-Being in the Elderly" Specialized Transportation Planning and Practice. Vol 1 (1982) pp. 61-72.

Gresset J. and Meyer F. "Risk of Automobile Accidents Among Elderly Drivers with Impairments or Chronic Diseases." Canadian Journal of Public Health. 85 (4): 282-285, 1994.

Guralnik et al. "Maintaining Mobility in Late Life." American Journal of Epidemiology. 137 (8):845-57, 1993.

Guralnik JM. Kaplan GA. "Predictors of healthy aging: prospective evidence from

the Alameda County study." American Journal of Public Health. 79(6):703-8, 1989 Jun.

Hakamies-Blomqvist L. "Older Drivers’ Accident Risk: Conceptual and Methodological Issues" Accident Analysis & Prevention. Vol. 30 No. 3 (1998) pp. 293-298.

Hakamies-Blomqvist L. "Research on Older Drivers: A Review" IATSS Research. Vol. 20 No. 1 (1996) pp. 91-101.

Hakamies-Blomqvist L. "Why Do Older Drivers Give Up Driving?" Accident Analysis & Prevention. Vol. 30 No. 3 (1998) pp. 305-312.

Hanson S. "Dimensions of the Urban Transportation Problem." In The Geography of Urban Transportation, S. Hanson, ed. The Guilford Press, New York, 1986.

Harris T. Kovar MG. Suzman R. Kleinman JC. Feldman JJ. "Longitudinal study of

physical ability in the oldest-old." American Journal of Public Health. 79(6):698-702, 1989 Jun.

Hu PS. Trumble DA. Foley DJ. Eberhard JW. Wallace RB. "Crash risks of older drivers: a panel data analysis." Accident Analysis & Prevention. 30(5):569-81, 1998 Sep.

Hu PS. Trumble D. Lu A. Driving Decisions and Vehicle Crashes Among Older Drivers. Oak Ridge, Tennessee, Oak Ridge National Laboratory, June 1993.

Idler EL. Kasl SV. "Self-ratings of health: do they also predict change in functional ability?" Journals of Gerontology. Series B, Psychological Sciences & Social Sciences. 50(6):S344-53, 1995 Nov.

Isler RB. Parsonson BS. Hansson GJ. "Age related effects of restricted head movements on the useful field of view of drivers." Accident Analysis & Prevention. 29(6):793-801, 1997 Nov.

Janecek MJ. "Transportation as a Component in Rural Health Care Services" A Report on the Mini Conference on Aging and Transportation. National Eldercare Institute on Transportation and American Association of Retired Persons, July 1994.

Jette AM. "Disablement outcomes in geriatric rehabilitation." Medical Care. 35(6 Suppl):JS28-37; discussion JS38-44, 1997 Jun.

Jette AM. Branch LG. "A Ten-Year Follow-Up of Driving Patterns among the Community-Dwelling Elderly." Human Factors Vol. 34 No. 1 (1992) pp. 25-31.

Johansson K. Bronge L. Lundberg C. Persson A. Seideman M. Viitanen M. "Can a physician recognize an older driver with increased crash risk potential? Journal of the American Geriatrics Society. 44(10):1198-204, 1996 Oct.

Johnson JE. "Rural elders and the decision to stop driving." Journal of Community Health Nursing. 12(3):131-8, 1995.

Kandrack MA. Grant KR. Segall A. "Gender differences in health related behaviour:

some unanswered questions." Social Science & Medicine. 32(5):579-90, 1991.

Kaplan RM. Anderson JP. Wingard DL. "Gender Differences in Health-Related Quality of Life." Health Psychology. 10 (2): 86-93, 1991.

Kaye HS. Is the status of people with disabilities improving? Disability Statistics Abstracts #21. Disability Statistics Center, Univ. of California San Francisco, May, 1998.

Kington R. Reuben D. Rogowski J. Lillard L. "Sociodemographic and Health Factors in Drving Patterns after 50 years of age." American Journal of Public Health. 84(8): 1327-1329, 1994.

Klein BEK. Klein R. Lee KE. Cruickshanks KJ. "Performance-Based and Self-Assessed Measures of Visual Function as Related to History of Falls, Hip Fractures, and Measured Gait Time" Ophthmology. Vol. 105 No. 1 (1998) pp. 160-164.

Lawrence RH. Jette AM. "Disentangling the Disablement Process." Journals of Gerontology: Social Sciences. 48(4): 173-182, 1996.

Lundberg C. et al. "Dementia and driving: an attempt at consensus." Alzheimer Disease & Associated Disorders. 11(1):28-37, 1997 Mar.

Lundberg C. Hakamies-Blomqvist L. Almkvist O. Johansson K. "Impairments of some cognitive functions are common in crash-involved older drivers." Accident Analysis & Prevention. 30(3):371-7, 1998 May.

Manton KG. Corder L. Stallard E. "Chronic disability trends in elderly United States populations: 1982-1994." Proceedings of the National Academy of Sciences of the United States of America. 94(6):2593-8, 1997 Mar 18.

Manton KG. "Demographic Trends for the Aging Female Population." Journal of the American Medical Women’s Association. 52 (3): 99-105, 1997.

Manton KG. Stallard E. Corder LS. "The dynamics of dimensions of age-related disability 1982 to 1994 in the U.S. elderly population." Journals of Gerontology. Series A, Biological Sciences & Medical Sciences. 53(1):B59-70, 1998 Jan.

Manton KG. "A longitudinal study of functional change and mortality in the United States." Journal of Gerontology. 43(5):S153-61, 1988 Sep.

Marottoli RA. Ostfeld AM. Merill SS. Perlman GD. Foley DJ. Cooney LM. "Driving Cessation and Changes in Mileage Driven Among Elderly Individuals." Journal of Gerontology: Social Sciences. 48(5):77-81, 1993.

Marottoli RA. Mendes de Leon CF. Glass TA. Williams CS. Cooney LM Jr. Berkman LF. Tinetti ME. "Driving cessation and increased depressive symptoms: prospective evidence from the New Haven EPESE. Established Populations for Epidemiologic Studies of the Elderly." Journal of the American Geriatrics Society. 45(2):202-6, 1997 Feb.

Marottoli RA. Richardson ED. "Confidence in, and Self-Rating of, Driving Ability Among Older Drivers" Accident Analysis & Prevention. Vol. 30 No. 3 (1998) pp. 331-336.

Martinez R. "Older drivers and physicians." JAMA. 274(13):1060, 1995 Oct 4.

McGrane, J. "The Perspective of the Transportation Provider" A Report on the Mini Conference on Aging and Transportation. National Eldercare Institute on Transportation and American Association of Retired Persons, July 1994.

Merrill SS. Seeman TE. Kasl SV. Berkman LF. "Gender differences in the comparison of self-reported disability and performance measures." Journals of Gerontology. Series A, Biological Sciences & Medical Sciences. 52(1):M19-26, 1997 Jan.

Mor V. Murphy J. Masterson-Allen S. Willey C. Razmpour A. Jackson ME. Greer D. Katz S. "Risk of functional decline among well elders." Journal of Clinical Epidemiology. 42(9):895-904, 1989.

Morgan R. King D. "The older driver - a review." Postgraduate Medical Journal. 71(839):525-8, 1995 Sep.

Muller PO. "Transportation and Urban Form: Stages and Spatial Evolution of the American Metropolis." In The Geography of Urban Transportation, S. Hanson, ed. The Guilford Press, New York, 1986.

Murray SL. "Driving and the elderly." Journal of the American Academy of Nurse Practitioners. 9(3):133-6, 1997 Mar.

Oldenheimer GL. "Dementia and the Older Driver." Clinics in Geriatric Medicine. 9(2):349-358, 1993.

Owsley C. Ball K. McGwin G Jr. Sloane ME. Roenker DL. White MF. Overley ET. "Visual processing impairment and risk of motor vehicle crash among older adults. JAMA. 279(14):1083-8, 1998 Apr 8.

Penning MJ. Strain LA. "Gender Differences in Disability, Assistance, and Subjunctive Well-Being in Later Life." Journals of Gerontology: Social Sciences. 49 (4): S202-S208, 1994.

Perryman KM. Fitten LJ. "Effects of normal aging on the performance of motor-vehicle operational skills." Journal of Geriatric Psychiatry & Neurology. 9(3):136-41, 1996 Jul.

Pinsky JL. Leaverton PE. Stokes J 3d. "Predictors of good function: the Framingham Study." Journal of Chronic Diseases. 40 Suppl 1:159S-167S, 181S-2, 1987.

Purvis CL. San Francisco Bay Area 1990 Regional Travel Characteristics: Working Paper #4. Planning Section, Metropolitan Transportation Commission: December 1994.

Rabbitt P. Carmichael A. Jones S. Holland C. When and Why Older Drivers Give Up Driving. AA Foundation for Road Safety Research Age and Cognitive Research Centre, Manchester: 1996.

Retchin SM. Anapolle J. "An overview of the older driver." Clinics in Geriatric Medicine. 9(2): 279-295, May 1993.

Rodgers W. Miller B. "A comparative analysis of ADL questions in surveys of older people." Journals of Gerontology. Series B, Psychological Sciences & Social Sciences. 52 Spec No:21-36, 1997 May.

Rosenbloon S. "Transportation Needs of the Elderly Population" Clinics in Geriatric Medicine. Vol. 9, No. 2 (1993) pp. 297-310.

Rosenbloom S. "The Travel Patterns of Elderly Women Alone: A Research Note" Specialized Transportation and Practices. Vol. 3 (1989) pp. 295-309.

Schieber F. "High-Priority Research and Development Needs for Maintaining the Safety and Mobility of Older Drivers." Experimental Aging Research. 20: 35-43, 1994.

Schoeffler LE. "Eyesight and the elderly." Oklahoma State Medical Association. 89(10):379, 1996 Oct.

Sims RV. Owsley C. Allman RM. Ball K. Smoot TM. "A preliminary assessment of the medical and functional factors associated with vehicle crashes by older adults." Journal of the American Geriatrics Society. 46(5):556-61, 1998 May.

Stamatiadis N. "Elderly Male and Female Drivers: How Different Are They?" Washington, DC, Transportation Research Board, from January 10-14, 1993, annual meeting.

Stamatiadis N. Deacon JA. "Trends in highway safety: effects of an aging population on accident propensity." Accident Analysis & Prevention. 27(4):443-59, 1995 Aug.

Strahan RF. Mercier CR. Mercier JM. O'Boyle MW. "Personality structure of elderly drivers." Perceptual & Motor Skills. 85(2):747-55, 1997 Oct.

Stutts JC. "Do older drivers with visual and cognitive impairments drive less?." Journal of the American Geriatrics Society. 46(7):854-61, 1998 Jul.

Thomas VS. Rockwood K. McDowell I. "Multidimensionality in Instrumental and Basic Activities of Daily Living" J Clin Epidemiol. Vol. 51 No. 4 (1998) pp. 315-321.

US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Health Statistics. The Longitudinal Study of Aging, 1984-90 computer file. SETS version 1.21. Hyattsville, Md., 1993.

US Department of Health and Human Services, Public Health Service, National Institutes of Health. Established Populations for Epidemiologic Studies of the Elderly: Resource Data Book. Bethesda, Md.,1986.

US Department of Transportation. The National Highway Traffic Safety Administration’s Traffic Safety Plan for Older Persons. US Department of Transportation, DOT HS-807-316, September 1988.

US Department of Transportation Bureau of Transportation Statistics. 1995 Nation’s Travel: Early Results from the 1995 Nationwide Personal Travel Survey.

Veevers J. "Women in the Driver’s Seat: Trends in Sex Differences in Driving and Death." Population Research and Policy Review. Vol. 1 (1982) pp. 171-182.

Verbrugge LM. Jette AM. "The disablement process." Social Science & Medicine. 38(1):1-14, 1994 Jan.

Verbrugge LM. "Longer life but worsening health? Trends in health and mortality of middle-aged and older persons." Milbank Memorial Fund Quarterly - Health & Society. 62(3):475-519, 1984.

Verbrugge LM. "Multiple roles and physical health of women and men." Journal of Health & Social Behavior. 24(1):16-30, 1983 Mar.

Verbrugge LM. Reoma JM. Gruber-Baldini AL. "Short-term dynamics of disability and well-being." Journal of Health & Social Behavior. 35(2):97-117, 1994 Jun.

Wallace RB. "The search to improve safe vehicular operation among older drivers: are we reaching our destination? [editorial]." Journal of the American Geriatrics Society. 46(5):652-3, 1998 May.

Warnes AM. Fraser DA. "Car Driving as a Social Skill." In Geragogics: European Research. The Haworth Press, 1992.

Weaver P. "Elder Mobility: Transportation Policy and Research Issues as We Move Towards the 21st Century" presented at the Mini-White House Conference on Aging and Transportation., Pittsburgh, Pennsylvania, May 24, 1994.

Wingard DL. "The Sex Differential in Morbidity, Mortality, and Lifestyle." American Review of Public Health. 5:433-58, 1984.

Winter SE. "Effects of Driving Cessation on the Older Adult." California State University Sacramento (1996), Master of Arts in Psychology Thesis.

Wiseman EJ. Souder E. "The older driver: a handy tool to assess competence behind the wheel." Geriatrics. 51(7):36-8, 41-2, 45, 1996 Jul.

World Health Organization. International Classification of Impairment, Disabilities and Handicaps. WHO, Geneva, 1993.

AA Foundation for Road Safety Research Age and Cognitive Centre Study

Aging in the Eighties: America in Transition

Assets and Health Dynamics Among the Oldest-Old [AHEAD]

Beaver Dam Eye Study

Established Populations for Epidemiologic Studies of the Elderly [EPESE]

Fatality Analysis Reporting System [FARS]

General Social Surveys

Health and Nutrition Examination Survey [NHANES]

Health and Retirement Study [HRS]

Human Aging: A Biological and Behavioral Longitudinal Study of Males

Informal and Formal Supports in Aging

Intergenerational Study of Parents and Children: 1962-1993

Iowa 65+ Rural Health Study

Longitudinal Study of Aging [LSOA] and Supplemental on Aging II [SOA II]

Massachusetts Health Care Panel Study

National Health Interview Survey of Disability

National Long-Term Care Survey [NLTCS]

National Survey of Families and Households

National Survey of Functional Health Status

National Survey of Problems Facing Elderly Americans Alone

Nationwide Personal Transportation Survey

San Francisco Bay Area Regional Travel Study

Time Use Longitudinal Study

Wisconsin Longitudinal Survey [WLS]

Populations: 2134 individuals (1156 men and 963 women) aged 55 to 101 from the University of Manchester’s Longitudinal Age Research volunteer panel.

Study design: Questionnaire on past experience and future experience of driving sent with abbreviated version of the Cornell Medical Index

Relevant Dates: 1992-1994

Type of health and functional data: Abbreviated version of the Cornell Medical Index

Mobility and transportation data: Driving history, thoughts of giving up driving in the future or reasons for having given up driving, current driving habits, responses to proposals and sanctions to increase safety for older drivers

Gender difference data: Data stratified by gender

General findings: Continued driving is associated with higher SES and lower Cornell Medical Index scores. Although the largest concern of both current drivers and former drivers is the loss of mobility that giving up driving would result, many former drivers have adapted well to alternative modes of mobility. Even so, over 50% of former drivers feel that public transportation is not adequate.

About one-third of current drivers say they intend to continue to drive until an unforeseen event forces them to cease driving, and they differ from current drivers who are willing to estimate a particular date for driving cessation in that those who continue to carry on driving are more confident in their driving ability and rely on the automobile more.

Although over 20% of ex-drivers reported loss of driving competence, less than 4% of those still driving reported noticing a decrease in driving competence in any of 14 categories.

Weakness with respect to the junction of issues of women, mobility, transportation and health: The AA Foundation study directly addresses issues of mobility, transportation and health, but its direct application to the American elder transportation situation must be questioned. In addition, because the questionnaire was not tailored directly to the needs of women, elder women’s issues may be neglected.

HRS Auxiliary Study

Populations: National panel study of cohorts born 1923 and earlier, 7447 respondents aged 70+ (including 2548 aged 80 and over) plus 775 younger spouses with oversamples of blacks, Hispanics and Florida residents

Relevant Dates: Wave 1 data collection completed in February 1994, Wave 2 completed in May 1996, Wave 3 data collection February-October 1998

Type of health and functional data: Detailed data on health conditions, cognition (and proxy cognition), health care and health care costs, job status, time use and expectations of the future

Mobility and transportation data: No direct data collection on these issues, to be linked with ADL data in LSOA2 and NLTCS

Gender difference data: Stratified by gender

General findings: Information on the economic and family issues surrounding late-life health

Weakness with respect to the junction of issues of women, mobility, transportation and health: AHEAD provides value in assessing the health changes in elders, especially in linkage with mobility-specific data

Populations: An initial cohort of 5924 from Beaver Dam, Wisconsin, of persons aged 43 to 84 years was identified from September 1987 to May 1988 and given a baseline visual examination. A follow-up examination was given from March 1992 through June 1995.

Type of health and functional data: Detailed data on visual acuity, contrast sensitivity, visual sensitivity and ambulation was determined. The participants were questioned on falls and fractures after age 40.

Gender difference data: Stratified by gender

General findings: Lower visual functioning was associated with gait time, and this suggests that visual functioning affects later-life mobility.

Weakness with respect to the junction of issues of women, mobility, transportation and health: The Beaver Dam Eye Study is a regional study that has as its focus visual functioning and its direct implications on ambulation, which may be of use as a proxy for the implications of visual functioning on community mobility and transportation.

Populations: 14,000 persons in four geographically-defined communities in East Boston, Massachusetts; Iowa and Washington Counties, Iowa; New Haven, Connecticut; and in a five county-wide region in north-central North Carolina.

Relevant Dates: Data collection 1981-1992 in Massachusetts and Iowa, 1982-present in Connecticut, 1986-present in North Carolina

Study design: Baseline and annual follow-up surveys

Type of health and functional data: Demographic characteristics, social and physical functioning, health service utilization

Mobility and transportation data: Automobile driving data from Iowa 65+ Rural Health Study, other proxy data for mobility from ADL and social interaction questionnaire topics

Gender difference data: Data stratified by gender

Weakness with respect to the junction of issues of women, mobility, transportation and health: Mobility issues not central in all four geographic areas of the EPESE

Populations: All crashes involving a fatality (either motorist or non-motorist) as reported by each US state transportation department

Relevant Dates: Yearly since 1975

Type of health and functional data: None

Mobility and transportation data: Specifics (age of participants, gender, posted speed limit, number and type of car involved, time of day) on accident

Weakness with respect to the junction of issues of women, mobility, transportation and health: The Fatality Analysis Reporting System is limited in its use to determining the specifics of health, transportation and mobility in elder women

Populations: A total of 32,380 completed interviews

Relevant Dates: Conducted during February, March, and April of 1972, 1973, 1974, 1975, 1976, 1977, 1978, 1980, 1982, 1983, 1984, 1985, 1986, 1987, 1988, 1989, 1990, 1991, 1993 and 1994.

Study design: Random sampling of US population and telephone interviews of approximately one and a half hours in length

Type of health and functional data: Detailed questions on health and ADL functioning disabilities

Mobility and transportation data: Community assistance

Weakness with respect to the junction of issues of women, mobility, transportation and health: This nationwide survey is broad enough in scope both to address a wide range social and community issues for elder mobility (that may not be considered elsewhere) and to limit its focus in any one area

Populations: 18,447 interviewed persons 12-74 years of age

Relevant Dates: 1976-1980

Study design: 25,286 were interviewed and 20,322 were medically examined (4,964 individuals were interviewed but not examined)

Type of health and functional data: The medical histories include items on medication, hospital care, tuberculosis, a variety of acute and chronic diseases, tobacco usage, physical activity, weight, height, vision disability, exposure to pesticides, gastrointestinal problems and, for females, a menstrual and pregnancy history.

Mobility and transportation data: Not included

Weakness with respect to the junction of issues of women, mobility, transportation and health: Provides baseline health data for a broad sample of the older population

Populations: Initial sample of 7600 households, national panel study of respondents from 1931-41 birth cohort, oversamples of Hispanics, blacks and Florida residents

Study design: Baseline in-home face-to-face interviews in 1992 for 1931-41 birth cohort and in 1998 for 1924-30 and 1942-47 birth cohorts

Mail follow-ups every second year and proxy interviews after death

Type of health and functional data: Detailed data on health conditions, cognition (and proxy cognition), health care and health care costs, job status, time use and expectations of the future

Mobility and transportation data: No direct data collection on these issues, experimental modules on functional health, ADLs, activities and time allocation

Gender difference data: Stratified by gender

General findings: Information on the economic and family issues surrounding late-life health

Weakness with respect to the junction of issues of women, mobility, transportation and health: HRS provides value in assessing the health changes in elders, especially in linkage with mobility-specific data

Populations: The basic design of the study involved the observation and examination, in 1957, of a group of 47 aged men (ranging in age from 65 to 92 years) who were in good health. Five years later a follow-up study was planned for the 39 men still alive. However, only 29 of the 39 men could be located and persuaded to return for further testing. The second follow-up, done in 1968, involved 19 of the surviving 23 men. The study was supported by grants from the National Institute of Mental Health. The data are arranged in files by year: 1957, 1962, and 1968. Included are psychiatric data, medical evaluative data, biographical and demographic variables, and various psychological and medical test scores. There are approximately 1,800 variables and 2,400 card-image equivalents.

Type of health and functional data: Comprehensive micro-view of health, aging and functioning

Weakness with respect to the junction of issues of women, mobility, transportation and health: While not focusing on population-based measures of gender, mobility and health, the Human Aging study provides and baseline view of aging and its concurrent physiological and mental changes

Populations: 1431 noninstitutionalized persons aged 40 and older living in three New York counties: Albany, Rensselaer and Schenectady

Study type: Personal interview

Relevant Dates: September 1988-February 1989

Type of health and functional data: Basic ADLs, data on household chores performed, variables on family relationships and social support networks

Mobility and transportation data: Ability to perform activities in the community alone and with the assistance of family and other social support networks

Gender difference data: Data stratified by gender

Weakness with respect to the junction of issues of women, mobility, transportation and health: Regional in nature

Populations: 2127 Detroit-area Caucasian families who had given birth to their first, second or fourth child in 1961

Relevant Dates: Initial in-person interviews in 1962 with mothers; follow-up interviews with mothers in 1963, 1966, 1977, 1980, 1985 and 1993; follow-up interviews with children in 1977, 1980, 1985 and 1993

Type of health and functional data: Behavioral, social and cross-generational transfer data

Mobility and transportation data: Social

Gender difference data: Focus on suburban mothers’ social changes through time

Weakness with respect to the junction of issues of women, mobility, transportation and health: Provides only an oblique view of female mobility and health for a regional cohort

Populations: 3762 persons 65 and over in 1981, the date of the initial interview, in Iowa and Washington counties in rural Iowa

Relevant Dates: Baseline survey between December 1991 and August 1982 with in-person follow-up surveys 3, 6 and 10 years after baseline and 1, 2 ,4, 5 and 7 years after baseline

Type of health and functional data: Major health conditions, nutrition, cognitive performance, activities of daily living, NIA-MacArthur Battery tests for physical performance, medical care utilization from the HCFA

Mobility and transportation data: Social networks and support, automobile driving habits, linked to Iowa state driving records

Gender difference data: Stratified by gender

Populations: 16148 persons aged 55 and over interviewed during the 1984 National Health Interview Survey formed the Supplement on Aging (SOA). The 1984 SOA formed the baseline for the Longitudinal Study of Aging (LSOA), which followed those 70 and over through telephone follow-up interviews in 1986, 1988 and 1990. A sample of 9447 persons aged 70 and over formed the second Supplement on Aging (SOA II) as part of the 1994 National Health Interview Survey. A second Longitudinal Study of Aging (LSOA II) will be conducted with the first follow-up interview conducted in 1997.

Type of health and functional data: Health conditions and impairments, linkage to HCFA Medicare records, the National Death Index, functional status

Mobility and transportation data: Transportation use, assistance with basic activities, social contracts, use of community services

Weakness with respect to the junction of issues of women, mobility, transportation and health: Although a fully national sample, this data does not directly address the mobility needs of female elders, especially community mobility in terms of automobile use

Populations: 1625 community-dwelling Massachusetts residents aged 65 and older

Relevant Dates: Baseline questionnaires in 1974-75 with reinterviews at 1.25 years, 6 years and 10 years

Type of health and functional data: General self-reported health status and DALYs data collected

Mobility and transportation data: Detailed mobility pattern data (trip typing, social mobility reliance

Gender difference data: Data stratified by gender

General findings: Although self-regulation appears to be the major influence on elder’s continued driving, continued reliance on driving is not closely related to an elder’s health status.

Weakness with respect to the junction of issues of women, mobility, transportation and health: Regional in nature, the Massachusetts Health Care Panel Study is general in nature and does not directly focus on women and relies on only general self-reported health status measures

Populations: 16114 adults interviewed nationwide during the 1994 National Health Interview Survey

Study design: The National Health Interview Survey on Disability (NHIS-D), Phase II, was administered at the same time as the NHIS 1994 core, NATIONAL HEALTH

INTERVIEW SURVEY, 1994. This questionnaire collected basic data on disability and was used as a screening device to determine eligibility for the second phase of the survey, the NHIS-D Disability Followback Survey.

Type of health and functional data: Detailed data on disability types, especially on non-end of life disabilities

Mobility and transportation data: Data on driving and other community transportation

Weakness with respect to the junction of issues of women, mobility, transportation and health: Focus of National Health Interview Survey on Disability not particularly on older persons, and thus the sample size is relatively small. However, there is enough detail for population estimates and for approaching some of the time mobility issues.

Populations: A national sample taken from Medicare beneficiary enrollment files

Sample design: The initial 1982 NLTCS was a sample of 35,008 persons, of which 6,393 were found to have at least one chronic impairment in the seven Instrumental Activities of Daily Living or nine Activities of Daily Living. This group was interviewed at home for data on health, functioning and other issues.

The 1984 NLTCS followed the 1982 cohort and 45% of the non-disabled 1982 population was rescreened for newly emergent chronic disability. In addition, a sample of individuals who became 65 since 1982 was screened for disability.

The 1989 NLTCS followed the 1982 and 1984 disabled cohorts and rescreened portions of the non-chronically disabled from the 1982 and 1984 samples. In addition, persons from the 1984 sample who had reached 75 years by 1989 were automatically rescreened.

The 1994 NLTCS followed the earlier cohorts, added a new sample of those reaching 65 since 1989 and rescreened non-chronically disabled members of the earlier cohorts.

Type of health and functional data: ADL and IADL assessment and general health conditions data collected, linkage with Medicare Part A and Part B from 1982 to 1995

Mobility and transportation data: Not assessed

Gender difference data: Data stratified by gender

Weakness with respect to the junction of issues of women, mobility, transportation and health: This national sample bears witness to the function of disability in respect to functional disability, but the NLTCS was not designed to focus on mobility

Populations: National sample of 13 000

Relevant Dates: A baseline questionnaire in 1987-88 with face-to-face reinterviews in 1992-94

Type of health and functional data: Health, well-being, DALYs and intergenerational assistance data

Weakness with respect to the junction of issues of women, mobility, transportation and health: May provide national baseline measures for intergenerational assistance that may reflect mobility assistance

Populations: The sample frame for the NHS included 1,537 GSS households from 1989 and 1,372 GSS households from the 1990 GSS for a total base sample of 2,909 households Second, the NHS selected for interview 342 elderly persons who were residing in the target households but had not been selected for GSS interviews.

Relevant Dates: 1990

Type of health and functional data: Assessment of ADL functioning and health status with particular emphasis on how these factors affect elder’s perceived well-being

Mobility and transportation data: Data on how mobility functioning affects elder’s quality of life

Weakness with respect to the junction of issues of women, mobility, transportation and health: Although the National Survey of Functional Health addresses the intersection of aging, health and physical functioning, its focus is on quality of life and basic ADLs rather than the ability of elder females to drive and maintain community mobility

Populations: 2002 persons aged 65 and over, weighted by sex, age, race, education and living arrangement with an oversample of 504 additional persons aged 75 and over

Relevant Dates: June 11-July 31 1986

Study type: Random digit dialing of 23,000 telephone numbers nationwide

Type of health and functional data: Self-reported ADLs, health status, cognitive assessment and types of assistance respondents reported receiving from family and the community

Mobility and transportation data: General questions on community mobility

Gender difference data: No specific interview topics based on respondent’s gender

Weakness with respect to the junction of issues of women, mobility, transportation and health: The National Survey of Problems Facing Elderly Americans Alone provides a baseline measure of the social aspects of elder life without focusing specifically on mobility or elder females

Populations: 95360 person in 42033 households nationwide contacted through random digit dialing

Relevant Dates: 1995 with similar studies conducted in 1983, 1977 and 1969

Type of health and functional data: Age, SES, weight and general functional health status ascertained

Mobility and transportation data: Daily trip logs fully detailing all personal trips (long and within the community) by each mode of transportation

Gender difference data: Data stratified by age and gender

General findings: Research based on the NPTS has suggested that aging female baby boomers are more likely to drive into late-life than earlier generations of elder females

Weakness with respect to the junction of issues of women, mobility, transportation and health: The data is quite general in terms of health status and does not directly address the mobility issues of elder females

Populations: Telephone travel survey of 10838 San Francisco Bay Area residents

Relevant Dates: 1990 with additional survey data from 1981 and 1965

Type of health and functional data: General mobility-related data on difficulty of walking, driving and use of public transportation

Mobility and transportation data: Detailed travel log data for three day period

Weakness with respect to the junction of issues of women, mobility, transportation and health: A regional sample that does not health and disability data with mobility questions

Populations: This combined data collection consists of data from 620 respondents, their spouses if they were married at the time of first contact, and up to three children between

the ages of three and seventeen living in the household.

Study design: The key features which characterized the 1975 time use study were repeated in 1981. In both of the data collection years, adult individuals provided four time diaries as well as extensive information related to their time use in the four waves of data collection. Information pertaining to the household was collected, as well as identical measures from respondents and spouses for all person-specific information. Selected children provided two time diary reports (one for a school day and one non-school day), an academic achievement measure, and survey measures pertaining to school and family life. In addition, teacher ratings were obtained. For each adult individual who remained in the sample through the 1981 study, a time budget was constructed from his or her time diaries containing the number of minutes per week spent in each of some 223 mutually exclusive and exhaustive activities. These measures provide a description of how the sample individuals were currently allocating their time and are comparable to the 87 activity measures created from their 1975 diaries. In addition, respondent and spouse time aggregates were converted to parent time aggregates for mothers and fathers of children in the sample. To facilitate analyses on spouses, a merged data file was created for 868 couples in which both husband and wife had complete Wave I data in either 1975-1976 or 1981.

Weakness with respect to the junction of issues of women, mobility, transportation and health: While this study does not focus on health or transportation issues, the Time Use Longitudinal Study may provide basic sociological background data for researchers interested in the integration of transportation and mobility in elders' lives.

Populations: Cohort of 10317 persons who graduated from Wisconsin high schools in 1957

Relevant Dates: Data collected from the cohort or their parents in 1957, 1964, 1975 and 1992 and from a sibling in 1977 and 1993

Type of health and functional data: Health and physical functioning self-reported assessment, caregiving received or given, social and family relationships

Mobility and transportation data: No data specific to transportation

Weakness with respect to the junction of issues of women, mobility, transportation and health: The Wisconsin Longitudinal Survey is a regional tool that focuses on neither mobility nor health status change, but does provide a long-term continuous cohort of an aging population